THE OHIO JOURNAL OF SCIENCE

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1 THE OHIO JOURNAL OF SCIENCE PUBLISHED BY THE OHIO STATE; UNIVERSITY SCIENTIFIC SOCIETY VOLUME XVIII 'NOVEMBER, 1917 No. 1 TABLE OF CONTENTS FORRMAN AND REED Tumors in Dogs. II 1 WAI/TON The Axial Rotation of Aquatic Microorgonisms and its Significance G NAPPER Concretionary Forms in the Greenfield Limestone 7 RICE Report of the Twent3'-seventh Annual Meeting of the Ohio Academy of Science 14 TUMORS IN DOGS. II. A Fibro-blastoma of the Alveolar Border of the Jaw Containing Giant Cells, (a Giant Cell Epulis). By JONATHAN FORMAN and CARLOS I. REED. (From the Laboratories of Pathology and Physiology of the Ohio State University) According to Wolff, ('13) the dog is more frequently afflicted with sarcoma than any other lower animal. Frohner observes that sarcomas in the dog occur most often in the subcutaneous tissues. This author also mentions /'Epulis sarkomatosa" as presenting itself frequently on the upper jaw of dogs and less frequently on the lower jaw. The specimen described here is not presented because of the rariety of the type, but because it apparently throws some light on the nature of the giant cells frequently seen in epulides. Epulis is a topographical term signifying any growth upon the gums. Used in this broad sense, it may cover tumors of bone, connective tissue, epithelium, inflammatory conditions, and simple hypertrophies of the gums such as are occasionally encountered in pregnancy. The term, however, has become restricted to those tumors which are seated upon the gum or the upper edge of the alveolar border and which are of mesenchymal origin. In man three types have been described;

2 2 The Ohio Journal of Science [Vol. XVIII, No. 1, first, the fibrous epulis; second, the giant cell epulis; and third, the endothelial variety described by Whitman ('14) and Ivy ('15). The term epulis, however, seems to us to be a poor one and we would prefer to see it replaced by the correct name of whatever type of tumor it happens to be. The so-called giant cell sarcoma or epulis of the jaw has been the subject of controversy. Some authorities claiming that it is a benign growth while others believe it to be malignant. Several causes have led to this confusion: first, the use of the term epulis, which does not define the type of growth; second, Fig. 1. A Photograph of the Tumor. too much importance has been attached to the presence of giant cells but without due attention to their nature; third, the giant cell fibro-sarcoma may have been confused with the endothelial variety described by Whitman ('14). The tumor upon which this paper is based occurred upon the upper jaw of a dog which came into the Laboratory of Physiology during the school year The dog was an adult mongrel shepherd whose age was unknown. The accompanying figure gives an adequate idea of the size and location

3 Nov., 1917] Tumors in Dogs of this growth. It measures 3 x 2 x 15 cm. and is attached by a pedicle 1 cm. in diameter to the gum margin between the incisor teeth. It is firm, and covered by a mucous membrane of normal color, except at the extreme tip, where the covering has taken on a warty appearance. The tumor is not ulcerated at any point. Microscopal examination reveals a fan-shaped section covered except at the point of attachment of the tumor by a normal appearing epithelium. The outer half of the tumor is composed of normal appearing fibro-blasts. Just beneath this in the connective tissue is a zone of giant cells. Fig. 2. Giant cells containing reticular fibrils. The distinctly neoplastic cells are more closely packed in the pedicle of the tumor. While there has occurred an elaboration of inter-cellular substances in this area, they are not so rich in amount as in the older portion of the tumor. There is, however, a sufficient degree of differentiation on the part of the connective tissue cells composing the tumor in this growing portion to place it among the benign fibroblastomas. Giant cells are generally thought to be produced by fusion of cells or else by division of the nucleus without a corresponding division of the cell body. Mallory ('11) has called attention to the presence of both types in sarcomas. Those, which are the product of an incomplete multiple mitosis of the tumor cells, he calls "The true tumor giant cell." These are much less frequently found than the other type and are indicative of the rapid rate of growth of the tumor. Since a careful search fails to reveal any evidence of mitosis in any of the nuclei of the giant cells seen in this specimen, it is probable that these belong to the fusion type of giant cell. It is usually stated that the type of giant cells due to fusion is most frequently found in tumors associated with bone,

4 4 The Ohio Journal of Science [Vol. XVIII, No. 1, although at times, as in this specimen, all the neoplastic cells are fibroblasts and there is no evidence of either bone or cartilage formation. This tumor, however, arose from or near the periosteum. From this close association with bone, it has been suggested that these giant cells were identical with osterclasts. This type, Mallory says, (loc. cit.) "Is due to endothelial leukocytes invading tumors, especially those involving bone, and fusing to form foreign body giant cells. They are not tumor cells (although the tumors containing them are the ones which receive the name giant cell sarcomas) and usually signify only erosion and disintegration of bone." In addition to this source, the origin of osteoclasts has been assigned to reticular cells and to osteoblasts. It would be of interest then to determine if possible whether the giant cells in this fibroblastoma were really brought about by a fusion of cells as they appear to have been and also whether the cells which entered into their formation were tumor cells or were cells that had infiltrated the tumor from some outside source. Sections from this specimen were impregnated with silver after the method of Maresch-Bielskowsky. By using this method, Dr. James H. Warren has studied the nature of the giant cell seen in early tubercles ('17). This technique as employed by Ferguson ('12) would appear to be well established as a specific stain for reticular fibrils. These fibrils are abundant in this tumor. This is not surprising when it is considered that this is a tumor of rather slow growth arising in the connective tissue of the jaw. Some of these fibrils appear to leave the cytoplasm, and are seen free, while others bear only a faint rim of cytoplasm. The giant cells are especially interesting when stained with this silver impregnation. In many of the smaller giant cells, which contain only a few irregularly placed nuclei, the arrangement of fibrils together with the outline of the protoplasm suggests that the giant cells have been formed by the fusion of the reticular cells. Even in some of the larger giant cells, reticular fibrils can be seen in the cell body. These facts together with the complete absence of any evidence of mitosis would make it appear that these cells have been formed by a fusion of the reticular cells rather than by the fusion of invading cells or by multiple mitosis of the tumor cells. This specimen represents a neoplasm of slow growth in close association with bone. Since there are normally reticular

5 Nov., 1917] Tumors in Dogs 5 cells at the point of origin of this tumor and since there is a close association of reticular fibrils with the giant cells as well as with the tumor cells, it seems indicated that the giant cells in this tumor are produced by the fusion of tumor cells and for this reason present a tendency to differentiate as do the cells from which the tumor arose. That this is not the only mode of origin of fusion giant cells seen in new growths is apparent from the description of the origin of such cells by Whitman ('14). An examination of the specimens of giant cell sarcoma in the Museum of Pathology at the Ohio State University has shown that some of the giant cells originate from endothelium. This agrees with Mallory. It is the behavior of the more undifferentiated cells that determines the clinical course of the growth of the tumor. Giant cells such as are seen in this specimen become, therefore, of secondary interest for they do not determine the classification of the tumor as a fibroblastoma. They, however, indicate that the tumor is relatively benign. This is in agreement with Ivy's conception ('15) that the presence of these giant cells indicates that the tumor is probably not malignant. SUMMARY. This tumor arising in the alveolar process of the upper jaw of a dog is a rather slowly growing fibroblastoma, which contains giant cells. By the application of the Maresch-Bielskowsky technique of impregnating with silver it is established that the tumor cells possess black argentiferous fibrils and that the giant cells present in this tumor are produced by the fusion of cells which also have these same fibrils in close association with them. BIBLIOGRAPHY. 1. Ferguson, The Application of the Silver Impregnation Method of Bielskowsky to Reticular and Other Connective Tissues. Am. Jour. Anat. Vol. XII, p Fohner. (Cited by Wolff). 3. Ivy, Mesothelial Tumors of the Jaws. Jour. Am. Med. Assn. LXIV, Mallory, Giant Cell Sarcoma. Jour. Med. Res. Vol. XIX, p Means & Forman, Precancerous Conditions of Face and Mouth. Dental Summary, XXXV, p Means & Forman, Epulis. Dental Summary. XXXVI, p Means & Forman, A Clinico-Pathologic Study of Early Malignant Conditions of Face and Mouth. Jour. Am. Med. Assn. Jan. 20, p Warren, James H., The Giant Cell in Tuberculosis. Jour. Med. Res. Vol. XXXVI. No. 2. May, Whitman, Giant Cell Endothelioma of the Gums. Jour. Med. Res. Vol. XXIV, p Wolff, Lehre von der Krebs Krankheit, Jena